Provider Demographics
NPI:1225460041
Name:BURKETT, CHRISTY (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:BURKETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 DEKALB AVE NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-2176
Mailing Address - Country:US
Mailing Address - Phone:404-783-2079
Mailing Address - Fax:
Practice Address - Street 1:1530 DEKALB AVE NE
Practice Address - Street 2:SUITE C
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-2176
Practice Address - Country:US
Practice Address - Phone:404-783-2079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006771101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health